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Interview with Ben Bradshaw: The smiling assassin breaking the GPC

13 February 2008

Health minister Ben Bradshaw is one of the Brown Government’s eager young things, genial in manner and quick to smile. He looks an unlikely assassin, but he may, just possibly, be the man responsible for breaking the GPC.

Health minister Ben Bradshaw is one of the Brown Government's eager young things, genial in manner and quick to smile. He looks an unlikely assassin, but he may, just possibly, be the man responsible for breaking the GPC.

Days before we meet, Bradshaw, seven months into a stormy reign as health minister, launched a stinging attack on the BMA's leadership for allegedly failing to represent ordinary GPs, as the Government upped the ante in its war of words with the profession.

As we speak the GPC is meeting, later to announce what some will see as a humiliating climbdown in the contract dispute.

So how does the health minister feel about apparently killing off the opposition from GPC leaders? Certainly, he is not slow about twisting the knife. ‘The feedback I'm getting from GPs on the ground is they're not sure the BMA leadership has handled the whole thing particularly well,' he says. ‘There's a significant body of people who don't feel they've been terribly well led.'

‘I think that's one of the reasons that Alan Johnson decided he wanted to write directly to GPs, because the impression was being given by the GPC negotiators that we were taking away existing QOF points from areas of clinical care, which is simply not the case.'

The Government's move to ditch proposed clinical improvements to the QOF, in favour of what many see as an obsession with GP opening hours, has prompted fierce debate. But Bradshaw stands by claims by his boss Mr Johnson that in using the QOF as its argument, the GPC has simply been passing ‘propaganda'

‘Access is also about quality, there's not a trade off,' he says. ‘For a lot of people they'd say well if I can't get to see my GP then the quality of the service I'm being offered suffers.'

GPC claim they were poised to clinch a deal with NHS Employers over extended hours before Gordon Brown intervened from on high at the last minute to demand a tougher settlement.

It is a charge Bradshaw flatly denies – NHS Employers' negotiating mandate, he claims, was never changed.

‘Ministers don't get into the details of negotiation in that way,' he says.

‘This suggestion that this is part of some hidden agenda to privatise primary care or privatise GPs is just nonsense,' he adds.

But in under doctored areas, such as the 38 PCTs singled out by the Darzi review to receive 100 new GP practices, private provision has an important role to play, he says.

‘The traditional models have not delivered the level of GP provision which those communities need or deserve. Not only the inequalities in health outcomes but the inequalities in the density of GPs across the country are pretty stark.

‘If as we've seen independent providers, either private sector or social enterprises, are prepared to come in and fill those gaps then I think that's something we should all welcome.

‘They are prepared to deliver more access in terms of hours of the day open,' he adds. ‘But we don't have an ideological approach to this.'

Is there an upper limit to private provision within primary care?

‘If all of the new provision was private the total would be 3% in the health service,' he says. ‘That's your upper limit but that's not going to happen because a good proportion of them are already going to existing GPs.'

And beyond that? If, for example, 50% of practices were to be privately run, would the NHS still be the NHS?

‘Well that's not going to happen is it,' he replies. ‘Unless the GPs decide to leave the health service, which I hope they don't.'

It's a possibility which, while remote, has been raised in recent weeks as GPs desperately consider their options.

A BMA briefing document used at LMC meetings up and down the country suggested that while the implications of mass resignation would be huge, the plan would also have ‘real advantages.'

It can't have escaped Bradshaw that the document also predicted mass resignation would have ‘catastrophic or terminal effects on the Government', but even before knowing that outcome of that meeting up the road, he seems unworried by the threat.

‘I don't sense a great deal of appetite in the profession for that,' Bradshaw says. ‘From what I read in your magazine and elsewhere there was quite a strong reaction when those slides came to light, from grassroots GPs.'

Other options discussed in the BMA document in question, he says, such as a boycott of Choose and Book or non-participation in the Summary Care Record project, would ‘be seen by the public as an act of bad faith.'

A former BBC journalist, whose photogenic, charismatic manner see him have more than a passing resemblance to a certain former Prime Minister, Bradshaw has been a health minister for just seven months.

Yet the minister admits the Government's threat to impose an even tougher deal if GPs refuse the government's offer – ‘gun-barrel negotiating' as it had been dubbed – has already won him many enemies in the profession.

‘It's not our preferred option, which is why we're working very hard to try to persuade GPs to sign up to the negotiated deal,' he says. ‘But as far as the Government is concerned … we were elected to do a job on behalf of the public and on behalf of patients. And we are committed to them to deliver extended hours.

The extended hours in evening and weekends must not be substituted by GPs reducing their core hours, he says.

But doesn't that leave a rather obvious loophole? Won't practices be tempted to close their doors for an afternoon now, before they are audited by their PCT, making it that much easier for them to earn the extended hours cash when the DES comes in?

There's an uncomfortable pause, and a civil servant steps in with an answer straight from the Sir Humphrey Appleby guidebook, warning that surely GPs wouldn't want to risk breaching their contract agreements for short term gain.

With that, Pulse's time with the minister is almost up – he has an appointment with Prince Charles to attend– so there's time for just one final question. The big one: are GPs paid too much?

Bradshaw has the answer down pat and gives his trademark smile.

‘I regularly and constantly defend the new contract. I think the new contract has brought huge benefits to health care and to primary care and to GPs in particular.

‘We've got record numbers of GPs, got record numbers of medical trainees wanting to become GPs, so I make no apology at all about the level that GPs in this country are paid. I think they do an excellent job and if you look at the outcomes that's absolutely right.'

So why did the Government this year call for a third successive pay freeze – given inflation, a third effective pay cut?

This time it's the smile that freezes.

‘That is in the context of a 55% pay increase,' he begins, before going on to talk about inflation. MPs, he argues, have volunteered to take a 1.9% pay rise.

Surely more battles with GP leaders lie ahead before his time is up.

Bradshaw's first seven months

June 07 – unveiled as new minister after weeks of uncertainty as to who will be on Alan Johnson's health team. Welcomed by BMA as part of fresh approach

October 07 – causes outrage after suggesting patients needing urgent dental care should see their GP

December 07 – Bradshaw admonishes BMA in contract row for putting ‘interests of members ahead of interests of patients'

February 08 – Bradshaw accuses BMA of ‘misrepresenting' the Government's contract offer. GPC later back down in dispute, declaring the Government's contract offer is ‘less damaging for general practice' than the alternative imposition.

Bradshaw on... GPC leadership Bradshaw on... GPC leadership

‘The feedback I'm getting from GPs on the ground is they're not sure the BMA leadership has handled the whole thing particularly well'

Bradshaw on... the private sector Bradshaw on... the private sector

'This suggestion that this is part of some hidden agenda to privatise primary care or privatise GPs is just nonsense'